Michael Paget

Simulation Training Improves Diagnostic Performance on a Real Patient With Similar Clinical Findings

BACKGROUND Training on a cardiopulmonary simulator improves subsequent diagnostic performance on the same simulator. But data are lacking on transfer of learning. The objective of this study was to determine whether training on a cardiorespiratory simulator improves diagnostic performance on a real patient. METHODS We randomly allocated first-year medical students at the University of Calgary to simulator training in one of three clinical scenarios of acute-onset chest pain: pulmonary embolism with right ventricular strain but no murmur, symptomatic aortic stenosis, or myocardial ischemia causing mitral regurgitation. Simulation sessions ran for 20 min, after which participants had a standardized debriefing session and reviewed the physical findings. Immediately following the training sessions, students assessed the auscultatory findings of a real patient with mitral regurgitation. Our outcome measures were accuracy of identifying abnormal auscultatory findings and diagnosing the underlying cardiac abnormality (mitral regurgitation). RESULTS Eighty-six students participated in the study. Students trained on mitral regurgitation were more likely to identify and diagnose these findings on a real patient with mitral regurgitation than those who had trained on aortic stenosis or a scenario with no cardiac murmur. The accuracy (SD) of identifying clinical features of mitral regurgitation for these three groups was 74.0 (36.4) vs 56.2 (34.3) vs 36.8 (33.1), respectively (P = .0005), and for diagnosing mitral regurgitation, the accuracy was 68.0 (45.4) vs 51.6 (50.0) vs 29.9 (40.7), respectively (P = .01). CONCLUSIONS Simulator training on mitral regurgitation increases the likelihood of diagnosing this abnormality on a real patient.

The effect of simulator training on clinical skills acquisition, retention and transfer.

Context  Prior research has demonstrated that residents have poor clinical skills in cardiology and respirology. It is not clear how these skills can be improved because the number of patients with suitable clinical findings whose cooperation might help residents to better develop these clinical skills is limited.

Podcasting in Medical Education: Can We Turn This Toy into an Effective Learning Tool?.

Advances in information technology have changed how we deliver medical education, sometimes for the better, sometimes not. Technologies that were designed for purposes other than education, such as podcasting, are now frequently used in medical education. In this article, the authors discuss the pros and cons of adapting existing technologies for medical education, caution against limiting evaluation of technologies to the level of rater satisfaction, and suggest a research agenda for formally evaluating the role of existing and future technologies in medical education.

Cognitive load imposed by ultrasound‐facilitated teaching does not adversely affect gross anatomy learning outcomes

Ultrasonography is increasingly used in medical education, but its impact on learning outcomes is unclear. Adding ultrasound may facilitate learning, but may also potentially overwhelm novice learners. Based upon the framework of cognitive load theory, this study seeks to evaluate the relationship between cognitive load associated with using ultrasound and learning outcomes. The use of ultrasound was hypothesized to facilitate learning in anatomy for 161 novice first‐year medical students. Using linear regression analyses, the relationship between reported cognitive load on using ultrasound and learning outcomes as measured by anatomy laboratory examination scores four weeks after ultrasound‐guided anatomy training was evaluated in consenting students. Second anatomy examination scores of students who were taught anatomy with ultrasound were compared with historical controls (those not taught with ultrasound). Ultrasounds perceived utility for learning was measured on a five‐point scale. Cognitive load on using ultrasound was measured on a nine‐point scale. Primary outcome was the laboratory examination score (60 questions). Learners found ultrasound useful for learning. Weighted factor score on “image interpretation” was negatively, but insignificantly, associated with examination scores [F (1,135) = 0.28, beta = −0.22; P = 0.61]. Weighted factor score on “basic knobology” was positively and insignificantly associated with scores; [F (1,138) = 0.27, beta = 0.42; P = 0.60]. Cohorts exposed to ultrasound had significantly higher scores than historical controls (82.4% ± SD 8.6% vs. 78.8% ± 8.5%, Cohens d = 0.41, P < 0.001). Using ultrasound to teach anatomy does not negatively impact learning and may improve learning outcomes. Anat Sci Educ 10: 144–151.

How do medical students form impressions of the effectiveness of classroom teachers

Teaching effectiveness ratings (TERs) are used to provide feedback to teachers on their performance and to guide decisions on academic promotion. However, exactly how raters make decisions on teaching effectiveness is unclear.

The application of reward learning in the real world: Changes in the reward positivity amplitude reflect learning in a medical education context

Evidence ranging from behavioural adaptations to neurocognitive theories has made significant advances into our understanding of feedback-based learning. For instance, over the past twenty years research using electroencephalography has demonstrated that the amplitude of a component of the human event-related brain potential - the reward positivity - appears to change with learning in a manner predicted by reinforcement learning theory (Holroyd and Coles, 2002; Sutton and Barto, 1998). However, while the reward positivity (also known as the feedback related negativity) is well studied, whether the component reflects an underlying learning process or whether it is simply sensitive to feedback evaluation is still unclear. Here, we sought to provide support that the reward positivity is reflective of an underlying learning process and further we hoped to demonstrate this in a real-world medical education context. In the present study, students with no medical training viewed a series of patient cards that contained ten physiological readings relevant for diagnosing liver and biliary disease types, selected the most appropriate diagnostic classification, and received feedback as to whether their decisions were correct or incorrect. Our behavioural results revealed that our participants were able to learn to diagnose liver and biliary disease types. Importantly, we found that the amplitude of the reward positivity diminished in a concomitant manner with the aforementioned behavioural improvements. In sum, our data support theoretical predictions (e.g., Holroyd and Coles, 2002), suggest that the reward positivity is an index of a neural learning system, and further validate that this same system is involved in learning across a wide range of contexts.